Prostate Cancer--Diagnosis, Treatment, and Side Effects
Prostate Cancer is the most commonly diagnosed cancer for men (other than skin cancer) and the second leading cancer killer of men (after lung cancer). The annual rate is the U. S. is close to 250,000 diagnoses and around 30,000 deaths. Utah is among a few states with a high rate of prostate cancer. Prostate cancer typically progresses slowly, but early detection and appropriate action matter to the long-term outcome.
Diagnosis is often based on screening by PSA, which is an imperfect indicator; new tests will soon be available. (Note that there is controversy PSA, esp. routine screening since PSA may lead to overtreatment. Note, at the same time, that age-based criteria matter to diagnosis, especially with a faster rising PSA and that PSA screening reduces the death rate somewhat.) The Digital Rectal Exam (DRE) is useful for feeling some tumors if performed by a skilled medical practitioner. If screening indicates suspicion, a biopsy is the next step, generally performed in a urologist's office without anesthesia. The results generally classify men into low risk, medium risk, and high risk, depending upon the Gleason score generated from the pathologist's rating of cells. Low risk is generally followed up with "active surveillance" (previously known as "watchful waiting") which is ongoing regular monitoring of all measures, including repeat biopsies if needed. Active surveillance can go on for a number of years and treatment may never be required. Note that the side effects discussed below do not occur with active surveillance, though anxiety may be present.
If medical intervention is necessary, there are many choices, presenting a complex decision for a man and his family. Surgery and radiation, effectively delivered, have generally equivalent outcomes in terms of "cure" and side effects. Yet there are different forms of both surgery and radiation. In general, the practitioner consulted will recommend the type of intervention that he/she practices; thus it is wise to get a second (even third or more) opinion.
Surgery typically involves removal of the prostate; procedures may involve opening the abdomen widely enough for a regular removal. Alternatively, technologically guided surgery through smaller openings has become more common.
Radiation typically involves one of several procedures: 1) External beam radiation of the prostate and the area around it; modern techniques use highly accurate beams. 2) Insertion of permanent radioactive seed to kill cells. 3) Insertion of tubes for short-terms administration of radioactive gas to kill cells.
For information about all of these choices, see websites provided in the Resources section of the website. For high risk or late stage cancer, hormone suppression and advanced chemotherapy are likely to be used. New developments in these forms of interventions are happening at a rapid pace.
New DNA tests on cancer cells are making the prediction of risk much better.
Side effects of prostate cancer treatments are predominantly of two kinds: erectile dysfunction (ED) and urinary incontinence, though other effects do occur. The incidence and severity of side effects is quite variable, depending each man's prior health and functioning, the stage of the cancer, the competence of the practitioner, and unspecified factors.
The final choice of treatment is a complex decision as there is no clear proof that any procedure is necessarily superior in terms of survival and side effects. Factors such as age, stage of the cancer, general health, and personal preference are relevant.
Certain aspects of diet, exercise, and other lifestyle factors appear to matter to the likelihood of prostate cancer, to the severity of the cancer, and to the outcome in terms of likelihood of "cure" and of side effects.
Medical Practitioners. Physicians, Registered Nurses, and Physician Assistants whose practices are related to prostate cancer can be found in nearly all hospitals in Utah and in many independent practices. Such practitioners are most likely to be in Urology, Radiation, or Oncology.
Library Resources. There are libraries devoted to cancer in many major treatment centers. In Utah, these include:
Huntsman Cancer Institute Library (Cancer Learning Center) where you can look at books and other material, check them out, or even take them on loan by mail.
Intermountain Medical Center (Huntsman-Intermountain Cancer Education Centers) can be found in various Intermountain Hospitals.
Internet Information. Be cautious about information about prostate cancer that you can find on the internet. We can recommend the following sites:
US Too (www.ustoo.org). This is a national organization that sponsors local support groups such as ours and has a useful website and regular newsletters with the latest information. If you are out of our Utah area, this website may help you find a support group near you.
Zerocancer (www.zerocancer.org) This is a national organization sponsoring research and treatment for prostate cancer with the aim of achieving zero prostate cancer. The national organization sponsors race events in many places in the U. S., including the local Zero race in Utah in June (see News).
Prostate Cancer Research Institute (PCRI) (www.pcri.org) This organization sponsors an annual conference in September each year with presentations by prostate cancer experts and anyone may attend (if you pay the fee). The website is rich with information from these presentations and other sources.
Prostate Cancer Foundation (www.pcf.org). The website has general information about prostate cancer and news reports of the latest research related to prostate cancer.
American Cancer Society (www.cancer.org). The general source of information about cancer with information specific to prostate cancer.
Medscape. Enter: reference.medscape.com. Type "prostate" in the box and select "prostate diagnosis and staging" for an informative slide show about prostate cancer.
Carter, H., Ballantine, M. D. Prostate Disorders: Your Annual Guide to Prevention, Diagnosis, and Treatment. 2015 (or later edition when available). Scientific American White Papers.
Ellsworth, Pamela, M. D., 100 Questions and Answers About Prostate Cancer, Third Edition (or later as available). Burlington, MA: Jones & Bartlett Learning. Often available complimentary through Abbvie (or Abbott).
Moyad, Mark, M. D., MPH. Promoting Wellness for Prostate Cancer Patients--Dr. Moyad's No BS Health Advice: A Step-by-Step Fuide to what Works and What's Worthless.